Gastric Adenocarcinoma after Gastric Bypass for Morbid Obesity: A Case Report and Review of the Literature

Abstract

Gastric adenocarcinoma after gastric bypass for morbid obesity is rare but has been described. The diet restriction, weight loss, and difficult assessment of the bypassed stomach, after this procedure, hinder and delay its diagnosis. We present a 52-year-old man who underwent Roux-en-Y gastric bypass 2 years ago and whose previous upper digestive endoscopy was considered normal. He presented with weight loss, attributed to the procedure, and progressive dysphagia. Upper digestive endoscopy revealed stenosing tumor in gastric pouch whose biopsy showed diffuse-type gastric adenocarcinoma. He underwent total gastrectomy, left lobectomy, distal pancreatectomy and splenectomy, segmental colectomy, and bowel resection with esophagojejunal anastomosis. The histopathological analysis confirmed the presence of gastric cancer. The pathogenesis of gastric pouch adenocarcinoma is discussed with a literature review.

Gastric Pouch Mixed Adenoneuroendocrine Carcinoma With a Mixed Adenocarcinoma Component After Roux-en-Y Gastric Bypass

“…6 The incidence of gastric cancer after bariatric surgery is rare, with few cases reported in the literature, 7 most of adenocarcinomas arising in the excluded stomach, 8 in contrast to our patient's tumor location in the gastric pouch. 6,[9][10][11][12][13][14] Gastric MANEC is a rare type of gastric cancer. 15 As defined by the 2010 WHO classification, MANECs are composed of both adenocarcinoma and neuroendocrine tumorcell components, with the latter comprising at least 30% of the whole neoplasm.…”

“…The Roux-en-Y gastric bypass (RYGBP) is one of the most common procedures currently performed for surgical treatment of severe obesity. 6 The incidence of gastric cancer after bariatric surgery is rare, with few cases reported in the literature, 7 most of adenocarcinomas arising in the excluded stomach, 8 in contrast to our patient’s tumor location in the gastric pouch. 6 , 9 - 14 …”

H. PYLORI INFECTION, ENDOSCOPIC, HISTOLOGICAL ASPECTS AND CELL PROLIFERATION IN THE GASTRIC MUCOSA OF PATIENTS SUBMITTED TO ROUX-EN-Y GASTRIC BYPASS WITH CONTENTION RING: a cross sectional endoscopic and immunohistochemical study

“…Therefore this procedure may theoretically contribute to late diagnosis of gastric cancer. Malignant gastric tumours after 5 to 22 years of the postoperative period have been described in 21 obese patients submitted to RYGB, and 2 of them were located in the gastric pouch (19,22) . Due to reports of late neoplasia after RYGB (19) , there is a concern regarding gastric pouch evaluation.…”

Pyloric stenosis after a Roux-en-Y gastric bypass: a case report

“…Bariatric surgery has provided an effective treatment for many of these patients but has resulted in short-term and long-term complications not typically seen in other surgical patients because of comorbidities and altered anatomy and physiology after surgery [2][3]. Although gastric outlet obstruction of the remnant stomach has been reported previously in the literature, all previous cases to our knowledge have been the result of a malignancy [4][5]. We report a case of benign gastric outlet obstruction of the remnant stomach after Roux-en-Y gastric bypass.…”